This project integrates multidisciplinary research into the influence of behavioral factors on the etiology and course of cardiovascular diseases. The objectives are to apply validated measures of psychological and social variables such as the coronary-prone behavior pattern, anxiety, and defenses against it (including denial), discontinuities in social background, life change, chronic dissatisfactions, and stress in the social milieu. Field studies in a variety of clinical groups and healthy populations will seek to relate these variables to each other, to measurements of pathologic processes in the cardiovascular system, and to clinical endpoints such as the emergence of clinical coronary heart disease, recurrence of myocardial infarction, and amount of atherosclerosis as determined by coronary angiography. These aims are extensions of recently published and exploratory work by the applicants. Unique features of the project include the array of advanced methods of behavioral science measurement and the ongoing collaboration with about 20 biomedical research teams which permits multiple replication of findings in different settings and logical interdigitation of related research because of the uniform psychosocial data-gathering procedures used. Cross-cultural studies are pursued with the help of international collaborators using translations of our test instrument. This work should yield two kinds of benefits: increased ability to identify persons at elevated risk of developing coronary disease, and increased understanding of the biological links between specific behavioral factors and cardiovascular endpoints. BIBLIOGRAPHIC REFERENCES: C.D. Jenkins, S.J. Zyzanski, R.H. Rosenman, "Risk of New Myocardial Infarction in Middle-Aged Men With Manifest Coronary Heart Disease", Circulation, 53:342-347, February 1976, No. 2. M.W. Hurst, C.D. Jenkins, R. Rose, "The Relation of Psychological Stress to the Onset of Medical Illness", Annual Review of Medicine, 27:301-312, 1976.